72016 2 dec e[1lv 12-27-16 … · kroh,karen3”° from: mochon, julie sent: tuesday, december 20,...
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Kroh,Karen3”°
From: Mochon, JulieSent: Tuesday, December 20, 2016 12:12 PMTo: Kroh, KarenSubject: FW: 6100 draft comments-Mainstay Life ServicesAttachments: 6100 comments-Mainstay Life Services.docx
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From: Dana Schutte Lmailto:[email protected]] DEC 2 72016Sent: Tuesday, December 20, 2016 11:34 AMTo: Mochon, Julie <[email protected]> Independent Regu’atorY
Subject: 6100 draft comments-Mainstay Life Services
Dear Ms. Mochon,
The comments for the 6100 draft regulations are attached for Mainstay Life Services. The other chapters would need
adapted accordingly.
Thankyou,
Dana Schutte I Chief Operating OfficerMainstay Life Services200 Roessler Road I Pittsburgh, PA 15220Tel: 412344.3640 Fax: 412.344.5486Email: [email protected]: www.mainstaylifeservices.org
This e-mail message, including any attachments, is far the sole use of the intended recipient(s) and may contain confidential and
privileged information. Any unauthorized review, use, disclosure or distribution is prohibited. If you are not the intended recipient,
please contact the sender by reply e-mail and destroy all copies of the original message.
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Mainstay Life ServicesComments Template
Chapter 6100
Citation: 6100.1. Purpose (a)
Discussion:
Recommendation:
Citation: 6100.2. Applicability
Discussion:
Recommendation:
Citation: 6100.3. Definitions
Discussion:
Recommendation:
Citation: 6100.41. Appeals
Discussion:
Recommendation:
Citation: 6100.42. Monitoring compliance
Discussion:
Recommendation:
Comments on Chapter 6100— Support for Individuals with an Intellectual Disability orAutismDatePage 2 of 29
Citation: 6100A3. Regulatory waiver
Discussion:
Recommendation:
Citation: 6100.44. Innovation project
Discussion:
Recommendation:
Citation: 6100.45. Quality management
Discussion:
Recommendation:
Citation: 6100.46. Protective services
Discussion: Unclear if ElM satisfies the dept. and county reporting requirement
Recommendation: Clarify if additional reporting beyond electronic systemreporting will be required.
Citation: 6100.47. Criminal history checks
Discussion:
Recommendation:
Citation: 6100.48. Funding, hiring, retention and utilization
Comments on Chapter 6100— Support for Individuals with an Intellectual Disability or AutismDatePage 3 of 29
Discussion:
Recommendation:
Citation: 6100.49. Child abuse history certification
Discussion:
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Citation: 6100.50. Communication
Discussion:
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Citation: 6100.51. Grievances
Discussion: It’s unclear at what point a phone call with a concern becomes agrievance.
Recommendation: Define grievance.
Citation: 6100.52. Rights team
Discussion: Redundant.. .no value added. These issues are addressed throughElM and Investigation Peer review committee. Counties couldn’t manage to attendthese for all providers.
Recommendation: Roll the review of rights violations and abuse as arequirement of the Restrictive ProcedurelHuman Rights Committee (dualcommittee). Require invitation to attend specific portion of the meeting forindividualslfamilies of any effected person.
Comments on Chapter 6100— Support for Individuals with an Intellectual Disability or AutismDatePage 4 of 29
Citation: 6100.53. Conflict of interest
Discussion:
Recommendation:
Citation: 6100.54. Recordkeeping
Discussion:
Recommendation:
Citation: 6100.55. Reserved capacity
Discussion: Costly if not funded.
Recommendation: Fund vacancies held for individuals while out of aresidential program.
Citation: 6100.81. HCBS provider requirements
Discussion:
Recommendation:
Citation: 6100.82. HCBS documentation
Discussion:
Recommendation:
Citation: 6100.83. Submission of HCBS qualification documentation
Comments on Chapter 6100— Support for Individuals with an Intellectual Disability or AutismDatePage 5 of 29
Discussion:
Recommendation:
Citation: 6100.84. Provision, update and verification of information
Discussion:
Recommendation:
Citation: 6100.85. Ongoing HCBS provider qualifications
Discussion:
Recommendation:
Citation: 6100.86. Delivery of HCBS
Discussion:
Recommendation:
Citation: 61 00.141. Annual training plan
Discussion: Training requirement for administrative and ancillary staff is too long.While these employees should be trained on the philosophy, the 8 of required and 12total hour requirement is beyond what would be necessary. Job skill training foradministrative staff should not be mandated.
Recommendation: 4 annually training hours for admin staff on EverydayLives, abuse, etc. No job skills training requirement is necessary.
Citation: 61 00.142. Orientation program
Discussion:
Comments on Chapter 6100— Support for Individuals with an Intellectual Disability or AutismDatePage6of29
Recommendation:
Citation: 6100.143. Annual training
Discussion: Training requirement for administrative and ancillary staff is too long.While these employees should be trained on the philosophy, the 8 of required and 12total hour requirement is beyond what would be necessary. Job skill trainingrequirement should not be mandated
Recommendation: 4 hours annually on Everyday Lives, abuse, etc. No jobskills training requirement should be mandated for administrativelancillarystaff.
Citation: 6100.144. Natural supports
Discussion:
Recommendation:
Citation: 6100.181. Exercise of rights
Discussion:
Recommendation:
Citation: 6100.182. Rights of the individual
Discussion:
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Citation: 61 00.183. Additional rights of the individual in a residential facility
Discussion:
Comments on Chapter 6100— Support for Individuals with an Intellectual Disability or AutismDatePage 7of29
Recommendation:
Citation: 6100.184. Negotiation of choices
Discussion:
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Citation: 6100.185. Informing of rights
Discussion:
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Citation: 6100.186. Role of family and friends
Discussion:
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Citation: 6100.221. Development of the PSP
Discussion:
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Citation: 6100.222. The PSP process
Discussion:
Comments on Chapter 6100— Support for Individuals with an Intellectual Disability or AutismDatePage 8 of 29
Recommendation:
Citation: 61 00.223. Content of the PSP
Discussion:
Recommendation:
Citation: 6100.224. Implementation of the PSP
Discussion:
Recommendation:
Citation: 61 00.225. Support coordination and TSM
Discussion:
Recommendation:
Citation: 6100.226. Documentation of support delivery
Discussion:
Recommendation:
Citation: 61 00.261. Access to the community
Discussion:
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Comments on Chapter 6100 — Support for Individuals with an Intellectual Disability or AutismDatePage 9 of 29
Citation: 6100.262. Employment
Discussion:
Recommendation:
Citation: 6100.263. Education
Discussion:
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Citation: 6100.301. Individual choice
Discussion:
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Citation: 6100.302. Transition to a new provider
Discussion:
Recommendation:
Citation: 6100.303. Reasons for a transfer or a change in a provider
Discussion: Discharge may be necessary if an individual’s behavior causes unduestress or extreme disruption to the other individuals in the home.
Recommendation: Add language that would allow for the rights of the others inthe home in the case of someone who may be causing an unhealthy, stressfulenvironment.
Comments on Chapter 6100— Support for Individuals with an Intellectual Disability or AutismDatePage 10 of 29
Citation: 6100.304. Written notice
Discussion:
Recommendation:
CitatIon: 6100.305. Continuation of support
Discussion: This can be an incredible burden when no willing provider is locatedwithin a reasonable time. We supported an individual for two years post dischargenotice (his request). This was detrimental to his happiness as well as for hishousemates.
Recommendation: Provide an alternative for individuals who are unable tofind a willing provider within a designated time period.
Citation: 6100.306. Transition planning
Discussion:
Recommendation:
Citation: 61 00.307. Transfer of records
Discussion:
Recommendation:
Citation: 6100.341. Use of a positive intervention
Discussion: Support. Good change of title from “Safe Behavior Managemeiit”
Recommendation:
Comments on Chapter 6100— Support for Individuals with an Intellectual Disability orAutismDatePage 11 of 29
Citation: 6100.342. PSP
Discussion:
Recommendation:
Citation: 6100.343. Prohibition of restraints
Discussion: Title can be misleading to appear that no restraints are allowed, ever
Recommendation: Change title to “Prohibition of certain types of restraints.”
Citation: 61 00.344. Permitted interventions
Discussion:
Recommendation:
Citation: 6100.345. Access to or the use of an individual’s personal property
Discussion:
Recommendation:
Citation: 6100.401. Types of incidents and timelines for reporting
Discussion:#16 Moving medication errors to a 24 hour reporting requirement createsyet another reason for direct care staff to contact managers during their personal time(weekends/holidays). This is an unnecessary burden since serious errors wouldresult in an emergency room visit which would then be reportable in ElM within 24hours. Lesser errors should continue to be reportable within 72 hours.#17 is too nebulous. “A critical health and safety event” is open to interpretationleaving providers vulnerable to the whims of monitors.
Comments on Chapter 6100— Support for Individuals with an Intellectual Disability or AutismDatePage 12 of 29
Recommendation:#16 Medication errors should not be on the 24 hour list.. .72 hours is sufficient.#17 “Critical health and safety event” should be removed.
Citation: 6100.402. Incident investigation
Discussion: It appears that all reportable incidents require an investigation.
Recommendation: Clarify which incidents require investigating or specifywhere to find such information.
Citation: 6100.403. Individual needs
Discussion:
Recommendation:
Citation: 61 00.404. Final incident report
Discussion:
Recommendation:
Citation: 61 00.405. Incident analysis
Discussion:
Recommendation:
Citation: 6100.441. Request for and approval of changes
Discussion: V
Comments on Chapter 6100— Support for Individuals with an Intellectual Disability or AutismDatePage 13 of29
Recommendation:
Citation: 6100.442. Physical accessibility
Discussion:
Recommendation:
Citation: 6100.443. Access to the bedroom and the home
Discussion:What about fire emergencies? While the regulation states thatemergency access should be immediate, I’m not sure how that’s possible. Staff aresometimes evacuating multiple people and don’t need to be unlocking more doorsthan necessary---they’re already dealing with hoards of keys and some individualswho need physical assistance to evacuate. If an individual chooses to not use thelock, they shouldn’t be required to have the key.. .although they can choose to havethe key. Requiring permission for each access unless it’s a life threateningemergency is unrealistic. What about changing linens or entering because of a leakin the ceiling while the individual is out of the home?
Recommendation: Change to “lockable” doors on bedrooms for individualswho choose to lock their door. Staff will wait for permission to enter (nonemergency) when the individual is home. Written consent for necessaryaccess while the individual is away.
Citation: 6100.444. Lease or ownership
Discussion:
Recommendation:
Citation: 6100A45. Integration
Discussion:
Comments on Chapter 6100— Support for Individuals with an Intellectual Disability or AutismDatePage 14 of 29
Recommendation:
Citation: 6100.446. Facility characteristics relating to size of facility
Discussion: I think this regulation may catch in its net the VERY INTEGRATED semiindependent, unlicensed apartment programs of some providers. It also violates therights of individuals who want to live near their friends and staff. It shouldn’t matterhow many apartments are in a building as long as the building is well integrated in acommunity that serves a mostly non-disabled population (non-campus setting—fewerthan 10% of units). These individuals navigate the community on their own and arecompetitively employed. They come and go as they please. Having the group withinclose proximity allows for a level of oversight that maximizes these opportunities forindependence. Some of these individuals may lose independence if they are forced tolive further away from their support circle. I’m not clear on the definition of facility. Ifeach apartment is billed separately (2 person unlicensed) is it a different “facility” thanthe apartment across the hall?
Recommendation: Carve out semi-independent unlicensed apartmentprograms within a larger integrated complexlcommunity (non-campus setting).Clarify what constitutes a facility.
Citation: 6100.447. Facility characteristics relating to location of facility
Discussion:
Recommendation:
Citation: 6100.461. Self-administration
Discussion:
Recommendation:
Citation: 6100.462. Medication administration
Discussion: Including life sharing providers seems excessive. The life sharingmodel is the most inclusive, natural model offered. Having these providers adhere to
Comments on Chapter 6100— Support for Individuals with an Intellectual Disability or AutismDatePage 15 of 29
storage and documentation requirements is counterproductive to this most naturalsupport
Recommendation: Define some less stringent medication training for lifesharing providers.
Citation: 6100.463. Storage and disposal of medications
Discussion:
Recommendation:
Citation: 6100.464. Labeling of medications
Discussion:
Recommendation:
Citation: 6100.465. Prescription medications
Discussion:
I Recommendation:
Citation: 6100.466. Medication records
Discussion:
Recommendation:
Citation: 6 100.467. Medical errors
Comments on Chapter 6100— Support for Individuals with an Intellectual Disability or AutismDatePage 16of29
Discussion:
Recommendation:
Citation: 6100.468. Adverse reaction
Discussion:
Recommendation:
Citation: 6100.469. Medication administration training
Discussion:
Recommendation:
Citation: 61 00.470. Exception for family members
Discussion: Support this.. ..include life sharing providers.
Recommendation: Include Life sharing providers in this section.
Citation: 6100.481. Department rates and classifications
Discussion:
Recommendation:
Citation: 6100.482. Payment
Discussion:
Comments on Chapter 6100— Support for Individuals with an Intellectual Disability or AutismDatePage 17of29
Recommendation:
Citation: 6100A83. Title of a residential building
Discussion:
Recommendation:
Citation: 6100.484. Provider billing
Discussion:
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Citation: 6100.485. Audits
Discussion:
Recommendation:
Citation: 6100.486. Bidding
Discussion:
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Citation: 6100.487. Loss or damage to property
Discussion:
Recommendation:
Comments on Chapter 6100— Support for Individuals with an Intellectual Disability or AutismDatePage 18 of29
Citation: 61 00.571. Fee schedule rates
Discussion: More of a commitment needs to be made to keeping fees in line withrising costs. (b) The Department will refresh the market-based data used in subsection (a) toestablish fee schedule rates at least every 3 years.
Recommendation: Adhere to methodology that utilizes Medicare Home HealthMarket Basket Index to adjust fees every year.
Citation: 6100.641. Cost-based rate
Discussion:
Recommendation:
Citation: 6100.642. Assignment of rate
Discussion:
Recommendation:
Citation: 61 00.643. Submission of cost report
Discussion:
Recommendation:
Citation: 6100.644. Cost report
Discussion:
Comments on Chapter 6100— Support for Individuals with an Intellectual Disability or AutismDatePage 19 of29
Recommendation:
Citation: 6100.645. Rate setting
Discussion:
Recommendation:
Citation: 6100.646. Cost-based rates for residential habilitation
Discussion:
Recommendation:
Citation: 6100.647. Allowable costs
Discussion:
Recommendation:
Citation: 6100.648. Donations
Discussion:
Recommendation:
Citation: 6100.649. Management fees
Discussion:
Recommendation:
Comments on Chapter 6100— Support for Individuals with an Intellectual Disability or AutismDatePage 20 of 29
Citation: 6100.650. Consultants
Discussion:
Recommendation:
Citation: 6100.651. Governing board
Discussion:
Recommendation:
Citation: 6100.652. Compensation
Discussion: (b) A bonus or severance payment, that is part of a separation package, is not anallowable cost.This is a cost of doing business and should be allowable. However, under a fee based system, thesecosts are irrelevant to the state.
Recommendation: Change bonus or severance packages to “aIIowabe”.
Citation: 6100.653. Training
Discussion:
Recommendation:
Citation: 6100.654. Staff recruitment
Discussion:
Recommendation:
Comments on Chapter 6100— Support for Individuals with an Intellectual Disability or AutismDatePage 21 of29
Citation: 6100.655. Travel
Discussion:
Recommendation:
Citation: 61 00.656. Supplies
Discussion:
Recommendation:
Citation: 6100.657. Rental equipment and furnishing
Discussion:
Recommendation:
Citation: 61 00.658. Communication
Discussion:
Recommendation:
Citation: 6100.659. Rental of administrative space
Discussion:
Recommendation:
Citation: 6100.660. Occupancy expenses for administrative buildings
Discussion:
Comments on Chapter 6100— Support for Individuals with an Intellectual Disability or AutismDatePage 22 of 29
Recommendation:
Citation: 6100.661. Fixed assets
Discussion:
Recommendation:
Citation: 6100.662. Motor vehicles
Discussion: (2) The provider shall keep a daily log detailing the use, maintenance and servicesactivities of vehicles.The “maintenance and services activities” is onerous to providers. Other oversight (state inspection,etc.) assure the safety of vehicles in PA.
Recommendation: Change to include only usage.
Citation: 6100.663. Fixed assets of administrative buildings
Discussion: (c) The provider shall receive prior written approval from the Department for a plannedmajor renovation of an administrative building with a cost above 25% of the original cost of theadministrative building being renovated.The “prior written approval” for “25% of the original cost” does not factor in real estate appreciationfor buildings held for decades and adds to the administrative burden of providers.
Recommendation: Remove or change to 25% of current building value.
Citation: 6100.664. Residential habilitation vacancy
Discussion:
Comments on Chapter 6100— Support for Individuals with an Intellectual Disability or AutismDatePage 23 of 29
Recommendation:
Citation: 6100.665. Indirect costs
Discussion: (d) The provider shall select an allocation method to assign an indirect cost inaccordance with the following: (1) The method is best suited for assigning a cost with a benefitderived. (2) The method has a traceable cause and effect relationship. (3) The cost cannot be directlyattributed to an HCBS. (e) The provider shall allocate a general expense in a cost group that is moregeneral in nature to produce a result that is equitable to both the Department and the provider.Providers are already required to follow the Federal Super Circular and GAAP for indirect costallocation. This section is redundant and not necessary.
Recommendation: Remove section (d).
Citation: 6100.666. Moving expenses
Discussion:
Recommendation:
Citation: 6100.667. Interest expense
Discussion:
Recommendation:
Citation: 6100.668. Insurance
Discussion:
Recommendation:
Citation: 6100.669. Other allowable costs
Comments on Chapter 6100— Support for Individuals with an Intellectual Disability or AutismDatePage 24 of 29
Discussion:
Recommendation:
Citation: 6100.670. Start-up cost
Discussion:
Recommendation:
Citation: 6100.671. Reporting of start-up cost
Discussion:
Recommendation:
Citation: 6100.672. Cap on start-up cost
Discussion: (a) A cap on start-up cost will be established by the Department.Currently, the state only has $200,000 in a fund to reimburse up to $5,000 per new individual for startup costs on a first come, first serve basis. If the state is not planning to fund every provider’s start upcosts at a high enough amount, this cap will not be an incentive for providers to open new homes.
Recommendation: Increase cap and fund this more realistically.
Citation: 6100.681. Room and board applicability
Discussion:
Recommendation:
Citation: 6100.682. Support to the individual
Comments on Chapter 6100— Support for Individuals with an Intellectual Disability or AutismDatePage 25 of 29
Discussion:
Recommendation:
Citation: 6100.683. No delegation permitted
Discussion:
Recommendation:
Citation: 6100.684. Actual provider room and board cost
Discussion:
Recommendation:
Citation: 6100.685. Benefits
Discussion:
Recommendation:
Citation: 6100.686. Room and board rate
Discussion:
i Recommendation:
Citation: 6100.687. Documentation
Discussion:
Comments on Chapter 6100— Support for Individuals with an Intellectual Disability or AutismDatePage 26 of 29
Recommendation:
Citation: 6100.688. Completing and signing the room and board residencyagreement
Discussion:
Recommendation:
Citation: 61 00.689. Modifications to the room and board residency agreement
Discussion:
Recommendation:
Citation: 6100.690. Copy of room and board residency agreement
Discussion:
Recommendation:
Citation: 6100.691. Respite care
Discussion:
Recommendation:
Citation: 6100.692. Hospitalization
Discussion:
Comments on Chapter 6100— Support for Individuals with an Intellectual Disability or AutismDatePage 27 of 29
Recommendation:
Citation: 61 00.693. Exception
Discussion:
Recommendation:
Citation: 61 00.694. Delay in an individual’s income
Discussion:
Recommendation:
Citation: 61 00.711. Fee for the ineligible portion of residential habilitation
Discussion: (c) The Department will refresh the market-based data used in subsection (a) toestablish Department-established fees at least every 3 years.
I Recommendation: Use Medicare Home Health Market Basket Index and adjustfees annually.
Citation: 6100J41. Sanctions
Discussion:
Recommendation:
Citation: 61 00.742. Array of sanctions
Discussion: If these are not licensing regulations, the language should not be sofocused On corrective action.
Comments on Chapter 6100— Support for Individuals with an Intellectual Disability or AutismDatePage 28 of 29
Recommendation: Change title to “Remediation.”
Citation: 6100.743. Consideration as to type of sanction utilized
Discussion:
Recommendation:
Citation: 6100.744. Additional conditions and sanctions
Discussion:
Recommendation:
Citation: 6100.801. Adult autism waiver
Discussion:
Recommendation:
Citation: 6100.802. Agency with choice
Discussion:
Recommendation:
Citation: 6100.803. Support coordination, targeted support management andbase-funded support coordination
Discussion:
Comments on Chapter 6100— Support for Individuals with an Intellectual Disability or AutismDatePage 29 of 29
Recommendation:
Citation: 6100.804. Organized health care delivery system
Discussion:
Recommendation:
Citation: 6100.805. Base-funded support
Discussion:
Recommendation:
Citation: 6100.806. Vendor goods and services
Discussion:
Recommendation:
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